Význam intenzity chemoterapie v konkomitantní chemoradioterapii lokálně pokročilého karcinomu hrdla děložního

Chemotherapy Intensity Importace in Concurrent Chemoradiotherapy of Locally Advanced Cervical Cancer

Objective:
Concurrent chemoradiotherapy with weekly cisplatin became a standard procedure in patients with locally advanced cervical carcinoma. The objective of this retrospective study was to evaluate the therapy toleration and the survival of patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy with weekly cisplatin of 40mg/m².

Subject and Method:
From January 2000 to December 2004, 40 patients with locally advanced cervical cancer were treated with concurrent chemoradiotherapy with weekly cisplatin of 40mg/m². Radical radiotherapy consisted of external beam radiotherapy 25 x 2 Gy to the pelvis, high-dose rate brachytherapy 6 x 4 Gy to the tumor, boost 7 x 2 Gy to the pelvic walls. 21 patients also recieved 22 x 2 Gy to the para-aortic lymphatic nodes.

Results:
Only 16 patients recieved full five doses of cisplatin. Causes of discontinuance of the chemotherapy : acute hematological toxicity with leukopenia (10), thrombocytopenia (1), anaemia (1), increased levels of creatinine (2), profuse vomiting (1), haematemesis (1). Stage dependent two-year overall survival (OS) was 72% (IIB) against 64% (III, IVA). Two-year disease-free survival (DFS) dependent on the number of cisplatin doses was 77% (≥ 3 doses) against 56% (<3 doses) in patients with IIB stage.

Conclusion:
Acute hematological toxicity with leukopenia was the most frequent cause of discontinuance of the chemotherapy. The results of two-year OS and DFS show difference in dependence on the number of applied doses of chemotherapy. However, the difference was not significant due to a low number of patients subject to the study.

Key words:
cervical carcinoma, concurrent chemoradiotherapy, cisplatin, leukopenia